The United States District Court for the District of Columbia grants a motion to dismiss a complaint alleging the mayor of Washington, D.C. and other government defendants have a policy and/or practice of failing to deduct expenses incurred by Medicaid applicants and recipients properly and failing to render fair hearing decisions within 90 days. In Eva Mae Givens v. Muriel Bowser, et al. (D.D.C., Civil Action No. 20-307 (EGS/ZMF), September 30, 2022).
Eva Mae Givens was a nursing home resident until her death in December 2020. She applied for Medicaid benefits in February 2019 to pay for her care and submitted proof of various outstanding medical bills of over $40,000. Ms. Givens believed these bills qualified for a Post Eligibility Medical Expense (PEME) deduction, which would have reduced her Medicaid spenddown. In May 2019, she was notified that she had qualified for Medicaid, but her submitted expenses were not credited. She was thereafter required to expend more than $2,000 per month from her resources toward her medical care. She could not use these funds to pay her outstanding medical bills.
In June 2019, Ms. Givens requested a fair hearing to address this issue. However, the hearing ultimately did not occur until June 2020. The Office of Administrative Hearings considered and dismissed her case with prejudice in December 2020. Ms. Givens filed a 42 U.S.C. § 1983 suit against the defendants in February 2020, seeking federal court intervention. The defendants filed a motion to dismiss in July 2020.
The court considers each claim of Ms. Givens’ complaint. First, the court finds that her PEME Deductions claim is moot. The PEME claims must be dismissed because the District of Columbia made corrective payments to the nursing homes in the amount being requested as a PEME credit. A refund of what she paid is a claim against the nursing homes, not the District.
Second, the court finds that the fair hearing claims must be dismissed for lack of jurisdiction due to mootness. The court also finds that the inherently transitory exception to the mootness doctrine, which permits a court to exercise jurisdiction over class claims even if a named plaintiff’s claims have become moot before class certification, does not apply.
Finally, the court finds that Ms. Givens’ Section 1983 claim must be dismissed for failure to state a claim. Her Amended Complaint fails to meet the requirements for a claim for municipal liability by stating a claim for a predicate constitutional violation and a claim that a custom or policy of the municipality caused the violation.
Although her Amended Complaint does claim that the District failed to give proper PEME credits and issue timely fair hearing decisions more than 40 times in three years, she only pleads facts about one incident — hers. It does not provide details about the other 40 violations; without these other facts, Ms. Givens cannot prove a single incident of unconstitutional activity sufficient to impose liability.